Question about insurance riders

Hello,


My company only offers a self funded policy through Aetna and they refuse to ad the bariatric rider to our policy.  I am having several complications from my first RNY such as, the surgeon left excessive surgery clips inside me as well as he did not make my pouch smaller.  He only re-routed me.  Sometimes I am in so much pain I can not lay down on my stomach and I have had to stop my car and get out because of the spasms in my stomach. 

Does anyone know what I can do to get my insurance company to cover my surgery as corrective since they don't carry the rider?  Please help.  Someone told me that if I told my doctor how much pain I am in that he could possibly make a case for me. I am actually working from home right now because of the pain and the spasms.


Thanks in advance,

What did you have done? Stomaphyx or something similar?

I had an RNY in 2007.  I found out 2 months ago that my surgery was never completed.  So my new surgeon submitted me as a new RNY and not a revision.  He also noted that I needed to have surgery clips removed from a previous surgery but the insurance came back with that they will allow for the removal of the surgery clips but nothing else related to anything bariatric.  I am going to call tomorrow and see if they cover the EGD with Sclerotherapy procedure.  If they do that, I can get that done a few times and that will hopefully allow me to lose enough weight to get my hip replacement.  I need to have that done too, but no surgeon will touch me until I get under 250.

Yeah, I have issues....

Your in a mess.  You may be able to get the insurance company to reverse the RNY as it is impacting and is dangerous to your health.  You will unlikely to get them to "fix" it though or change it to another surgery (e.g.; DS) without one hell of a fight.  If your previous doc really screwed up and these aren't natural complications, your best option is to sue the doctor for funds to fix it.

I'm not sure what the options with RNY are in a case such as this.  Lapband for example, many insurance companies will cover the removal of the band (for health reasons), but will not allow revision to another surgery or replacement of the band.  In these cases, people have worked a half & half scenario, where the surgeon will bill the insurance for band removal but cash-pay for the new-band/revision.  Most post-op complications however related strictly to WLS you will be on your own.

Thanks.  Was  not the answer I was hoping for but I am going to try some other options.....I am in the process of getting another job with a major insurance company and maybe they offer all of the options I need to get myself fixed. 

I can not sue my doctor because VA has a strict 2 year limit of suing your medical providers and my surgery was 3 years ago.  I will get myself taken care of, it is just going to take longer than I want it to.